眼内窥镜辅助下硅油取出联合人工晶状体悬吊术的临床观察  

Clinical observation of silicone oil removal combined with sulcus suturing of intraocular lenses assisted by endoscopy

作　　者：俞永珍 彭亮红 张春丽 陈京霞 邹秀兰 张楚 周文杰 章梦一 余洋洋 程天豪 邹玉平 YU Yongzhen;PENG Lianghong;ZHANG Chunli;CHEN Jingxia;ZOU Xiulan;ZHANG Chu;ZHOU Wenjie;ZHANG Mengyi;YU Yangyang;CHENG Tianhao;ZOU Yuping(Department of Ophthalmology,General Hospital of Southern Theatre Command,Guangzhou 510010,Guangdong Province,China;University of Traditional Chinese Medicine,Guangzhou 510405,Guangdong Province,China;The First School of Clinical Medicine,Southern Medical University,Guangzhou 510515,Guangdong Province,China)

机构地区：[1]中国人民解放军南部战区总医院眼科,广东省广州市510010 [2]广州中医药大学,广东省广州市510405 [3]南方医科大学第一临床医学院,广东省广州市510515

出　　处：《眼科新进展》2023年第7期547-552,共6页Recent Advances in Ophthalmology

基　　金：广东省自然科学基金项目(编号:2019A1515011732);广州市科技计划项目(编号:202002030413)。

摘　　要：目的 评价眼内窥镜辅助下硅油取出联合人工晶状体(IOL)悬吊术的安全性与疗效。方法 将2018年6月至2022年5月在中国人民解放军南部战区总医院眼科行眼内窥镜辅助下硅油取出联合IOL悬吊术的32例(32眼)晶状体囊膜不完整的硅油填充眼纳入研究。记录手术时间,观察术前及术后1 d、1个月、6个月、12个月最佳矫正视力(BCVA)、眼压、角膜内皮细胞密度、角膜内皮细胞面积变异系数、六边形细胞比例和角膜内皮细胞数的变化,观察并记录术后IOL位置,同时记录术中、术后并发症情况。结果 术中硅油取出的时间为15.8~45.2(21.3±7.5)min, IOL悬吊手术的时间为16.7~33.6(22.3±6.8)min,联合手术的总时间为29.8~53.2(34.7±8.8)min。术前BCVA(logMAR)为1.913±0.854,术后1 d、1个月、6个月、12个月的BCVA(logMAR)分别为1.319±0.790、0.934±0.610、1.003±0.710、0.963±0.689,与术前相比,术后1个月、6个月及12个月患者BCVA均显著提高(均为P<0.05)。术后不同时间患者眼压与术前比较,差异均无统计学意义(均为P>0.05)。术后不同时间角膜内皮细胞密度、角膜内皮细胞面积变异系数、六边形细胞比例和角膜内皮细胞数与术前比较,差异均无统计学意义(均为P>0.05)。术后1 d、1个月、6个月、12个月所有患者IOL的倾斜度波动于3°~5°,IOL的偏心量波动于0.25~0.32 mm,悬吊的IOL均无明显倾斜且位置居中。随访期内,视网膜脱离复发1眼(3.1%),均未见硅油残留和持续性角膜水肿发生。结论 眼内窥镜辅助下硅油取出联合IOL悬吊术是治疗晶状体囊膜不完整的硅油填充眼安全有效的方法。Objective To evaluate the safety and effect of endoscopy-assisted silicone oil removal combined with sulcus suturing of intraocular lens(IOL).Methods A retrospective study was performed on 32 patients(32 eyes with silicone oil for damaged lens capsule)who underwent endoscopy-assisted silicone oil removal combined with sulcus suturing of IOLs in the Ophthalmology Department of PLA Southern Theater Command General Hospital from June 2018 to May 2022.The operation time was recorded.The best corrected visual acuity(BCVA),intraocular pressure(IOP),corneal endothelial cell(CEC)density,coefficient of variation(CV)of CEC area,percentage of hexagonal cells,and the number of CEC were measured pre-operation,1 day,1 month,6 months,and 12 months post-operation.The location of IOL after the operation was recorded,as well as the intraoperative and postoperative complications.Results The average operation time of silicone oil removal was(21.3±7.5)min(15.8-45.2 min),the average operation time of sulcus suturing of IOL was(22.3±6.8)min(16.7-33.6 min),and the average total operation time of the combined surgery was(34.7±8.8)min(29.8-53.2 min).The mean BCVA(logMAR)was 1.913±0.854,1.319±0.790,0.934±0.610,1.003±0.710,and 0.963±0.689 pre-operation,1 day,1 month,6 months,and 12 months post-operation,respectively,showing BCVA improved significantly at 1 month,6 months,and 12 months after surgery compared with the preoperative condition(all P<0.05).The IOP,CEC density,CV of CEC area,percentage of hexagonal cells,and the number of CEC post-operation had no significant differences compared with those pre-operation(all P>0.05).The IOL in all patients tilted from 3°to 5°and decentered from 0.25 mm to 0.32 mm at 1 day,1 month,6 months,and 12 months post-operation,while the sutured IOL showed no significant tilt or decentration.During the follow-up,retinal detachment relapsed in 1 eye(3.1%),while no silicone oil remnant or persistent corneal edema was found.Conclusion Endoscopy-assisted silicone oil removal combined with sulcus suturi

关 键 词：内窥镜 硅油取出术 人工晶状体悬吊术 人工晶状体倾斜度 人工晶状体偏心量 

分 类 号：R779.6[医药卫生—眼科]